Measles: photo, symptoms, treatment, prevention of measles
- Causes of Measles
- Measles development mechanism
- Measles classification
- Symptoms of measles
- Complications and possible effects of measles
- Measles diagnosis
- Measles treatment
- Measles prevention
Measles (morbilli) is a highly contagious acute viral infection, manifested by high (febrile) temperature, specific exanthema, symptoms of general intoxication, generalized inflammatory lesions of the pharyngeal mucosa, and respiratory organs.
The measles contagiousness index is almost 100%, i.e. the risk of infection in an unvaccinated person in contact with a patient is extremely high. The disease remains one of the leading causes of death among young children around the world.
Causes of Measles
The causative agent of the disease is an RNA virus belonging to the genus Morbillivinis (family Paramyxoviridae). It is characterized by poor stability in environmental conditions: it is inactivated by exposure to ultraviolet radiation, sunlight, drying, and disinfection treatment. Heating to 50 ° C also has a devastating effect on the virus. At room temperature, it remains viable for a maximum of 1 or 2 days, but more often not longer than 4 hours. In order to maintain activity for several weeks, he needs a lower temperature - the optimum temperature interval is from -15 to -20 0 С. Despite the instability in the external environment, there have been cases of the spread of strains over a long distance through the ventilation system in a separate building.
The source and reservoir of viruses is a sick person. They are distributed by airborne droplets. A large amount is excreted with mucus when coughing, sneezing, or simply talking, starting from the last 2 days of the latent period, throughout the prodromal period, and continuing until the 4th day of the rash. The patient is not dangerous to others from the 5th day of the appearance of maculopapular rash. Sometimes the period of contagiousness lasts up to 10 days from the beginning of the formation of exanthema. Cases of asymptomatic carriage of infection have not been identified.
Often measles sick children under 5 years. Adults who have not undergone compulsory vaccination are less likely to get sick, but their risk of infection is very high, and the disease is more severe than in children. In the spring-winter period, the peak of incidence is observed, and the decline occurs in August and September. After recovery, a persistent lifelong immunity is maintained with the preservation of measles antibodies in the blood. Newborns whose mothers have had measles have colostral (maternal) immunity, which lasts up to 3 months of the baby’s life. Therefore, measles infection in these months is unlikely. Known isolated cases of intrauterine infection of the fetus from the mother who had measles during gestation.
Measles development mechanism
The introduction of viruses into the body occurs through the epithelium of the respiratory tract, the villi of which swell, areas of metaplasia and necrosis of the mucous membranes appear, vascular congestion is detected. Focal lymphohistiocytotic infiltration is formed in the submucosal layer. Then the viruses enter the bloodstream - primary viremia, after which, with its current, they reach elements of the reticuloendothelial system in which they accumulate. In the spleen, lymph nodes, etc., cells called Warthin-Finkeldey are detected at this time. They have gigantic sizes and many cores.
After growth, reproduction and activity in the lymph nodes, the viruses re-enter the bloodstream - secondary viremia, affecting all types of white blood cells. At this time, the person appears the first clinical signs of the disease.
Measles viruses, affecting T-lymphocytes, suppress both cellular and humoral immune responses. As a result, immunity decreases, the body becomes susceptible to various pathogenic and conditionally pathogenic microflora, which ends with the development of serious secondary complications in the form of respiratory infections and a violation of vitamin metabolism with a sharp decrease in retinol and ascorbic acid.
The pathogen is predisposed to integumentary tissues - conjunctiva, skin, oral mucosa, integumentary epithelium of the respiratory organs. Very rarely is measles encephalitis diagnosed, in which viruses infect the brain.
Forms of measles:
- mitigated and others.
Periods of the disease:
- incubation (latent);
- catarrhal stage;
- stage rash.
- recovery period.
Forms of measles that differ in severity:
- mild form;
- moderately severe;
- severe form.
Symptoms of measles
The duration of the incubation period varies from 1–2 weeks, sometimes up to 17 days. In cases of the introduction of a specific immunoglobulin is extended to 3 weeks. The cyclicality of the typical form of measles is divided into several periods: catarrhal, period of rash and recovery (convalescence).
Catarrhal (prodromal) period is acute. Body temperature reaches 38.8–40 0 С and is accompanied by chills. The manifestations of general intoxication are growing - severe pain in the head, severe weakness, weakness, sleep disturbance, lack of appetite, irritability, etc. The symptoms of intoxication in adults are more pronounced, in children are smoothed.
The first sign of the disease is a bad cold, accompanied by copious serous or serous-purulent discharge. Catarrhal affections of the mucous membranes of different parts of the pharynx are manifested by a dry "barking" cough, hoarseness, and sometimes stenosis of the larynx. At the same time, inflammation of the conjunctiva of the eyes ( conjunctivitis ) with hyperemia and marked swelling of the eyelids develops. Because of the purulent discharge from the eyes of the patient, it is often difficult to open his eyelids in the morning. There is burning and itching in the eyes, tearing, photophobia.
In children, symptoms of catarrhal inflammation prevail. On examination of the pharynx, the granularity of the posterior wall and marked hyperemia of the pharynx are noted. Puffy face. Against the background of conjunctival redness, hemorrhages (hemorrhages) are visible in the retina of the eye. In adults, signs of regional lymphadenitis and airway lesions come first. Lymph nodes, often cervical, are enlarged and painful on palpation. With auscultation of the lungs breathing hard, dry rales are heard. In some cases, symptoms of dyspepsia - nausea, diarrhea, belching, or heartburn - are associated with the above symptoms.
At about 2 or 3 days the first wave of fever subsides, the temperature decreases and the patient experiences relief, but the next day it rises sharply again, aggravating intoxication and catarrhal phenomena. On the mucous membrane of the cheeks in the region of the molars (less often on the gums and lips) there are Velskiy-Filatov-Koplik specks, which are small whitish formations that look like semolina grains with a red border around the perimeter. They are a pathognomic sign of measles.
Simultaneously with specific spots or until they appear on the mucous membrane of the soft and part of the hard palate, a measles enanthema forms — red spots, each of which does not exceed the size of the pin head. Merging after 1 or 2 days from the moment of appearance, they cease to be noticeable against the background of general redness.
The catarrhal stage lasts no more than 3-5 days in children, in adults it lasts no more than a week.
The period of rash replaces catarrhal. Measles rash on the skin is a characteristic feature of this period. It initially appears behind the ears and on the scalp in the area of hair growth, spreading to the face, neck and chest. On the second day, the skin of the shoulders, arms, back, abdomen is covered with a rash, on the third - of the lower extremities, including the fingers, and on the face becomes pale. Such a sequence of spreading the rash, characteristic of measles, is a significant criterion for differential diagnosis.
Spotty-papular exanthema is more pronounced in adults than in children. It has a tendency to merge and the acquisition of hemorrhagic nature in severe disease.
The period of rash is considered the height of measles. Against the background of the appearance of a skin rash, fever becomes maximally pronounced, the symptoms of intoxication are aggravated, the catarrhal symptoms intensify. Examination of the patient reveals hypotension, tachycardia , signs of bronchitis and / or tracheobronchitis.
The period of convalescence or pigmentation occurs after about 8-10 days from the onset of the disease, in adults a few days later. Body temperature returns to normal, signs of catarrhal inflammation gradually disappear. Skin rashes regress in the order they appear. In their place remain pigmented areas that completely disappear in 5–7 days, but leaving behind a temporary, scaly, peeling, especially on the face. The patient feels satisfactory.
In this period, an asthenic syndrome often develops, manifested by symptoms of neurological disorders - decreased muscle tone and skin reflexes, tremor of the head and / or hands. Episodes of convulsions are possible. These phenomena are transient.
Measurable measles is one of the atypical clinical forms of infection. This variant of measles is diagnosed in people who have previously experienced this infection or have undergone passive or active immunization. Significant differences from the typical form:
- longer incubation;
- shortened period of catarrhal phenomena;
- absence of Velsky – Filatov – Koplik rash;
- complete absence or minimal severity of signs of intoxication;
- small amount of rash elements;
- atypical sequence of rashes: exantmatous rash may appear either immediately on the skin of the whole body, or in the reverse sequence - ascending from the lower extremities to the face.
Abortive measles is another variant of the atypical form of the disease. The beginning is similar to typical measles, but the symptoms subside already by 2-3 days. Febrile temperature is kept on the first day of the rash. Rash is localized only on the skin of the face and trunk.
In hypertoxic measles intoxication is pronounced. Hemorrhagic variant of atypical measles is manifested by hematuria, multiple hemorrhages in the mucous membranes and skin, stool mixed with blood.
Complications and possible effects of measles
Various consequences arise due to the weakening of the immunity, which is why a viral infection is complicated by the bacterial infection. In patients with measles, secondary bacterial pneumonia is often diagnosed. Rare, but possible stomatitis.
Other typical complications of the respiratory organs:
- sore throat ;
- pleurisy ;
- bronchitis ;
- laryngitis ;
- laryngeal stenosis.
On the part of the digestive system:
- enterocolitis with intestinal dysfunction;
- measles hepatitis.
From the lymphatic system:
- mesenteric lymphadenitis .
The greatest danger is damage to the nervous system. Infection can lead to the development of meningoencephalitis or meningitis, as well as polyneuritis. Inflammatory brain damage - encephalitis - in children may be accompanied by convulsions, hyperkinesis, progressive visual impairment, paralysis.
In a typical form of measles, diagnosis is not difficult, it is based on a characteristic clinical picture and epidemiological data.
- Clinical analysis of blood . A viral infection is characterized by a decrease in the number of leukocytes (leukopenia) and lymphocytes (lymphopenia) per unit volume of blood. With a complication of a bacterial nature, an increase in the number of leukocytes (leukocytosis), neutrophilic granulocytes (neutrophilia) and ESR is detected.
- The immunological method - RPHA (direct hemagglutination reaction) - is necessary for the detection of measles antibodies.
- The reaction of inhibition of agglutination (rtga) is a specific diagnostic test, which allows, depending on the growth of measles antibodies, to confirm the diagnosis.
- Serological testing to detect antibodies to the virus itself or its components.
- Enzyme-linked immunosorbent assay (ELISA) is an immunological study that helps detect antibodies to a virus. In the acute process, an increase in specific IgM immunoglobulins is detected, in the case of a chronic or previously transferred infection, an IgG antibody is present.
- Immunofluorescence (MFA) Methods - immunofluorescent examination by various methods for the quantitative and qualitative determination of antibodies and antigens.
Bacteriological analysis of nasopharyngeal flushing and serological studies are rarely used in clinical practice, as their results are retrospective.
Depending on the complications prescribed additional instrumental studies. If pneumonia is suspected, an x-ray of the lungs is necessary, for meningitis - lumbar puncture, brain damage - electroencephalography or rheoencephalography of the brain.
Measles is usually treated on an outpatient basis. Hospitalization in the infectious disease department is required in case of severe disease with complications. Compliance with bed rest is necessary throughout the entire period of fever and in the next two days after normalization of temperature.
Specific etiotropic therapy has not yet been developed. Treatment is carried out symptomatic, aimed at stopping the manifestations of the disease and preventing the development of complications. Intoxication in case of mild disease is relieved by drinking plenty of water. In the conditions of a hospital carry out detoxification therapy with intravenous administration of saline and polarizing solutions.
To lower the temperature, antipyretic and nonsteroidal anti-inflammatory drugs are used. Antihistamines help relieve itching and irritation. Vitamins are necessary to compensate for their deficiency. Reception of antiviral drugs from the first days of the disease significantly improves its course. With the threat of a bacterial infection or the onset of pneumonia, laryngitis, bronchitis or other inflammations of the respiratory tract, a course of broad-spectrum antibiotics is required. Catarrhal manifestations are removed by mucolytics and anti-inflammatory aerosols. When conjunctivitis treatment adds eye drops.
The patient must observe the hygiene of the eyes, mouth and whole body. Rinse eyes with furatsilinom, strong tea or a weak solution of baking soda, and pharynx and the entire oral cavity with chlorhexidine or other antiseptic. For inflammation of the larynx, accompanied by stenosis, or measles encephalitis, large doses of corticosteroids are required.
The most reliable prevention of measles is routine vaccination with live measles vaccine, conducted in accordance with the vaccination schedule developed, to create active immunity against measles viruses. According to the plan, the first combined vaccination against three infectious diseases at once - mumps, measles and rubella - is given to one-year-old babies, when passive (inborn) immunity ceases to act, transmitted to them through the placenta from the mother.
The introduction of associated vaccines against these infections on the same day with vaccination against diphtheria, polio, tetanus, hepatitis B, chickenpox, etc. is permitted. The issue of simultaneous vaccination is decided individually by the pediatrician for each child, based on their health.
The following vaccination (revaccination) is given to children at the age of 6 before starting school. Adolescents up to 17 years old inclusively, and adults up to 35 years old who have not been vaccinated and who have not had pain before, are also given a vaccine against measles. According to the instructions put two vaccinations, the interval between which should not be less than 3 months. People in the outbreak zone and not previously vaccinated, required compulsory vaccination, regardless of their age.